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PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NAME: Moffat County Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 -9704 <br />FACILITY° WILLIAMS FORK MINE <br />LOCATION: 1030 CR 107 <br />CRAIG, CO 81626 <br />ATTN Jerry Nettleton, Supv <br />i HARGEMONiTCe,.:i:, e'E vF" ,!:tvii'.; <br />C00034142 024 -A <br />PERMIT NUMBER I I DISCHARGE NUMBER <br />MONITORING PERIOD <br />_ MM /DD/YYYY MM /DD/YYYY <br />01/01/2014 03/31/2014 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Mine Dewatering to Sedimentation Basin Prior to Discha <br />External Outfall <br />No Discharge <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments —re prepared under my direction or <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />PARAMETER <br />EX <br />OF ANALYSIS <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Nickel, potentially dissolvd <br />SAMPLE <br />to the best of my knowledge and belief hue accurate and complete I am av are that then are <br />including the possibility of fine and imprisonment for <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />ir�D ��ti� �� <br />- -, <br />Cl$ <br />slgnlficantpenalttesforsubmittmgfalseinformation <br />now ng violations <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />M /DDIYfYYY <br />TYPED OR PRINTED <br />MEASUREMENT <br />013221 0 <br />PERMIT <br />* * " " ** <br />" *`` <br />*' <br />"`` *` <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Selenium, potentially dissolvd <br />SAMPLE <br />MEASUREMENT <br />013231 0 <br />PERMIT <br />' * *`* <br />* * " ** <br />' * "` <br />" " *' <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Oil and grease <br />SAMPLE <br />MEASUREMENT <br />0358210 <br />PERMIT <br />* * *' *' <br />"' * "* <br />" "" <br />*' * "' <br />"'* <br />10 <br />mg /L <br />Contingent <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />INST MAX <br />Chromium, trivalent total recoverablE <br />SAMPLE <br />•` * "' <br />`* " <br />"' * "`* <br />* " ** <br />"` <br />MEASUREMENT <br />042621 0 <br />PERMIT <br />* * * * ** <br />" * *'* <br />" "" <br />" "'' <br />"" <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />DAILY MX <br />Flow, in conduit or thru treatment plat <br />SAMPLE <br />MEASUREMENT <br />500501 0 <br />PERMIT <br />Req. Mon. <br />Req. Man. <br />MGD <br />" " *" <br />" "" <br />Monthly <br />INSTAN <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Solids, total dissolved <br />SAMPLE <br />MEASUREMENT <br />702951 0 <br />PERMIT <br />' * * * ** <br />* * *" <br />*`" <br />"x "" <br />Req. Mon. <br />Req. Mon. <br />mg /L <br />Quarterly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Mercury, total (as Hg) <br />SAMPLE <br />` *` *•* <br />" " ** <br />" "" <br />' "` <br />" "` <br />MEASUREMENT <br />719001 0 <br />PERMIT <br />•' *` <br />"* *` <br />" "' <br />Req. Mon. <br />` "" <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments —re prepared under my direction or <br />TELEPHONE <br />DATE <br />supervision in accordance with a system designed to assure that qua,ified personnel properly gather and <br />f y, _ -; <br />valuate the information submitted Based cn my inquiry of the person or persons who manage the <br />e „k ' � ,N . 4;. - •; <br />system or those persons directly responsible for gathering the information the information submitted is <br />d 9 <br />! P- _ y,if .- <br />`; +f', , Gi t dirp" J4 ,-j <br />to the best of my knowledge and belief hue accurate and complete I am av are that then are <br />including the possibility of fine and imprisonment for <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />ir�D ��ti� �� <br />- -, <br />Cl$ <br />slgnlficantpenalttesforsubmittmgfalseinformation <br />now ng violations <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />M /DDIYfYYY <br />TYPED OR PRINTED <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible sheen is observed. Qtrly sampling instructions - I.C.12, pg 11. <br />Fe nri .. -s ( i'Cn! Previous editions may be used. 0- '10/201 3 n <br />